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Case Report: Severe hypernatremia from psychogenic adipsia.

Sarah Manning1, Rehan Shaffie1, Shitij Arora1

  • 1Division of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA.

F1000Research
|February 3, 2017
PubMed
Summary

A rare case of psychogenic adipsia caused severe hypernatremia in a 56-year-old male. Successful treatment involved fluid resuscitation, mirtazapine, and clonazepam, highlighting a multidisciplinary approach for this condition.

Keywords:
adipsiaaltered mental statushypernatremiainfectionosmolalityosmotic demyelinationparanoiastroke

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Area of Science:

  • Internal Medicine
  • Nephrology
  • Psychiatry

Background:

  • Hypernatremia, a critical condition with high mortality, often presents in emergency settings.
  • Psychogenic adipsia, characterized by a compulsive avoidance of drinking, can lead to severe dehydration and electrolyte imbalances.

Purpose of the Study:

  • To report a unique case of hypernatremia secondary to psychogenic adipsia.
  • To illustrate the diagnostic and therapeutic challenges associated with this rare condition.

Main Methods:

  • A case study of a 56-year-old male patient presenting with severe hypernatremia.
  • Clinical evaluation, laboratory investigations, and psychiatric assessment.
  • Treatment with intravenous fluids, mirtazapine, and clonazepam.

Main Results:

  • The patient was diagnosed with psychogenic adipsia after a prolonged period of voluntary water refusal.
  • Successful management of hypernatremia and resolution of symptoms were achieved through a combination of fluid therapy and psychotropic medications.
  • The patient showed significant clinical improvement and stabilization of serum sodium levels.

Conclusions:

  • Psychogenic adipsia is a rare but serious cause of hypernatremia requiring prompt diagnosis and management.
  • A combined medical and psychiatric approach is crucial for successful treatment outcomes.
  • This case underscores the importance of considering behavioral causes in patients with unexplained electrolyte disturbances.